Abstract [en]

The elderly cared for in emergency care have an incidence between 11–51% to develop acute confusion during the care period. The condition is related to increased morbidity and mortality among the elderly. Multifactorial causes lie behind the elderly being affected. Acute confusion is a clinical diagnosis, at present there are not biomarkers or examinations that can identify the condition. Acute confusion requires early awareness, swift investigation, medical care and well adapted health care environment in order for the patient to recover.

Purpose:

To describe nurses experiences in detecting, preventing and caring for patients suffering from acute confusion in emergency care.

Design:

A qualitative interview with five nurses working within geriatric emergency care at two hospitals in the south of Sweden.

Result:

Three categories emerged in the result; strategies to identify and assess signs of acute confusion, strategies and hinders for preventative measures and good nursing upon acute confusion, and improvement proposals for the care of elderly suffering from acute confusion. Nurses used observation, communication, and gathering of information from medical records and relatives in order to identify acute confusion. A comprehensive view in care, continuity in contacts, adaption of health care environment and relatives engagement were important factors to prevent acute confusion and provide good nursing. Hindering factors were a result of shortcomings in the health care environment, insufficient resources and time, and lack of knowledge among other requisite staff regarding appropriate reception and approach.

Conclusion:

An evidence-based screening instrument which identifies various states of confusion would render assessment and documentation easier for nurses. Personal centered care built upon that such is planned based on a comprehensive view and continuity in contacts, and that relatives are more engaged in care, is advocated by the nurses. Health care environment shall be adapted, be calm and supportive in form. Staff that work with confused patients need more sufficient knowledge regarding appropriate reception and approach to render patient recovery easier.